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Pre Existing Condition?


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#1 drago

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Posted 22 October 2009 - 12:40 AM

Presently, I am insured through Blue Cross Blue Shield of California.

This is a bit confusing, because my parents live in Connecticut, but my mother works for a company based in San Fransisco - she travels for work every week. So her insurance is from CA. I have COBRA (since I am no longer a 'student') from her company because it was better (and, yes, cheaper) than me getting my own coverage.

However, this past year I have lived in Massachusetts, Maine, and Alaska, and I'm now moving to North Carolina. There is a strong possibility that I will be moving around quite a bit for the next few years, hopefully awake enough to start a career. :-\

I've been trying to see what coverage for me would be like on my own, since it is likely I'll have to take on my own insurance plan sooner or later. Unfortunately, a lot of insurance companies want the state I live in as part of the estimate. Well, what state do I live in? The one I'm in now? The one I was in the longest for the year? The one of my permanent residence?

I am specifically worried about pre-existing conditions and other issues having a life-long disorder like narcolepsy can cause for insurance. According to some basic research I've done, a 12-month waiting period could apply to any treatment I get for narcolepsy (?!) if I somehow land myself in the "pre-existing condition" arena.

This is totally new territory for me; my parents have been categorically unhelpful with this, telling me that I can "always count on them" rather than trying to help me find out more about the insurance system. Maybe they lack my paranoia gene (or my bad luck), but wanting to help and be there doesn't mean they will be able to; and, unfortunately, they won't be around forever. Does anyone have any advice, or resources, on figuring out insurance? Or for insurance issues with illnesses like Narcolepsy? Should I be worried that I'd be moving off of a parental unit's insurance onto my own? (Would that count as "non-employer insurance?") I know I pay COBRA now, but it is still technically part of my parent's plan.

Thanks,
drago

#2 amazingracie28

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Posted 22 October 2009 - 11:38 AM

Presently, I am insured through Blue Cross Blue Shield of California.

This is a bit confusing, because my parents live in Connecticut, but my mother works for a company based in San Fransisco - she travels for work every week. So her insurance is from CA. I have COBRA (since I am no longer a 'student') from her company because it was better (and, yes, cheaper) than me getting my own coverage.

However, this past year I have lived in Massachusetts, Maine, and Alaska, and I'm now moving to North Carolina. There is a strong possibility that I will be moving around quite a bit for the next few years, hopefully awake enough to start a career. :-\

I've been trying to see what coverage for me would be like on my own, since it is likely I'll have to take on my own insurance plan sooner or later. Unfortunately, a lot of insurance companies want the state I live in as part of the estimate. Well, what state do I live in? The one I'm in now? The one I was in the longest for the year? The one of my permanent residence?

I am specifically worried about pre-existing conditions and other issues having a life-long disorder like narcolepsy can cause for insurance. According to some basic research I've done, a 12-month waiting period could apply to any treatment I get for narcolepsy (?!) if I somehow land myself in the "pre-existing condition" arena.

This is totally new territory for me; my parents have been categorically unhelpful with this, telling me that I can "always count on them" rather than trying to help me find out more about the insurance system. Maybe they lack my paranoia gene (or my bad luck), but wanting to help and be there doesn't mean they will be able to; and, unfortunately, they won't be around forever. Does anyone have any advice, or resources, on figuring out insurance? Or for insurance issues with illnesses like Narcolepsy? Should I be worried that I'd be moving off of a parental unit's insurance onto my own? (Would that count as "non-employer insurance?") I know I pay COBRA now, but it is still technically part of my parent's plan.

Thanks,
drago



Sounds like you do have a confusing situation! I work in insurance, and as long you have continuous coverage (doesn't matter if its Cobra or not or if its your parents' plan or not) then you shouldn't be subject to any preexisting clauses. The important thing is not to let your coverage lapse!! Not even for a day-then you'd be subject to preexisting. As far as your state of residence, I've not come across that problem before. I know you can run into problems with providers being out of network so you may want to ask an insurance agent. I lied-actually now that I think about it, I have in the past come across patients who have had Medicare HMO policies with a specific coverage area who spent summers up north and winters down south (snowbirds). They had a whole lot of trouble with their plans not covering them when they were out of their coverage areas (like if a New Yorker with a New York coverage area needed care while in Florida, Florida is out of the coverage area), so half the year their plans were useless. If you plan on doing lots of moving around you should probably call the plan your looking into and explain your situation to them to make sure of their coverage area. The other pain in the *ss option is to switch plans every time you move. Like I said though, don't let coverage lapse at all, and keep your certificates of creditable coverage from any insurance company you may leave (they are supposed to send one out once coverage ends stating what dates you were covered-if they don't, it would be a good idea to ask for one as it saves time and hassle later on). Hope this helps a little.

#3 amazingracie28

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Posted 22 October 2009 - 11:46 AM

Sounds like you do have a confusing situation! I work in insurance, and as long you have continuous coverage (doesn't matter if its Cobra or not or if its your parents' plan or not) then you shouldn't be subject to any preexisting clauses. The important thing is not to let your coverage lapse!! Not even for a day-then you'd be subject to preexisting. As far as your state of residence, I've not come across that problem before. I know you can run into problems with providers being out of network so you may want to ask an insurance agent. I lied-actually now that I think about it, I have in the past come across patients who have had Medicare HMO policies with a specific coverage area who spent summers up north and winters down south (snowbirds). They had a whole lot of trouble with their plans not covering them when they were out of their coverage areas (like if a New Yorker with a New York coverage area needed care while in Florida, Florida is out of the coverage area), so half the year their plans were useless. If you plan on doing lots of moving around you should probably call the plan your looking into and explain your situation to them to make sure of their coverage area. The other pain in the *ss option is to switch plans every time you move. Like I said though, don't let coverage lapse at all, and keep your certificates of creditable coverage from any insurance company you may leave (they are supposed to send one out once coverage ends stating what dates you were covered-if they don't, it would be a good idea to ask for one as it saves time and hassle later on). Hope this helps a little.



PS-now that I'm thinking about it, you might also want to make sure that whatever policy you're looking at covers Narcolepsy and things like sleep studies. I've run into lots of policies that have exclusions for sleep disorders and treatments for sleep disorders..... also check deductibles-if treatments for sleep disorders/sleep studies are subject to deductible that may cause a problem too-I've seen patients whose policies have $5000 deductibles and they can't afford to have sleep studies done...its like not even having insurance unfortunately. (Sorry-I see a lot of crap dealing with insurance companies-just trying to make you aware of potential traps...)

#4 PWN in Deutschland

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Posted 22 October 2009 - 05:48 PM

i too have spent a lot of time working with insurance companies and have to agree that the biggest and most important thing for you is not to let your coverage lapse!!! Even if this means paying for crappy coverage that costs too much because you can't find anything else at the moment, you still have to do it. the new HIPPA laws actually provide an extension that says your coverage can lap for (I THINK) 60 days without causing any PEC complications, but insurance companies will still give you a hard time over it and unless you are really legal savvy, it's not worth getting into.

there are some medical coverage options available through the USGov for recent graduates that can't find jobs, but there is an age out for those programs. either way, it's worth checking in to. as far as the moving around, you may want to reconsider whatever is causing you to do that. insurance aside, it is really hard to find a good doctor that is well-versed in N that you like. if you are constantly changing cities and docs, your continuity of care will not be very good and will likely cause problems for your treatment.

that being said... both BCBS and United healthcare offer options in their plans that can make out of network docs the same cost as network docs; however, these plans are extremely expensive. insurance companies are fully within their rights to charge you more for insurance because of your health conditions because you are looking at personal and not employer-sponsored health coverage. again, more money. if you are able to get around any health questions like, "are you currently being treated for an on-going medical disorder or have you ever etc." you shouldn't have a problem with elevated costs due to health conditions. the catch of course is that if you lie (or tell the truth in a creative way), they can drop you.

you said that your p's are very supportive in a non-informative way... hopefully that means they are supportive financially. united health care has a larger national network, so they are probably a better option for travel, so as long as money is not an issue, i'd start there.

lots of luck!